Which beta-blockers have demonstrated mortality benefit in HFrEF and what key parameter should be regularly monitored?

• A. Carvedilol, metoprolol succinate, bisoprolol; monitor BP, HR, signs of decompensation.
• B. Propranolol, nadolol; monitor liver enzymes.
• C. Labetalol; monitor blood glucose.
• D. Atenolol; monitor respiratory rate.

Answer: (A)

In heart failure with reduced ejection fraction, beta-blockers that have been shown to improve survival are carvedilol, metoprolol succinate, and bisoprolol. These drugs blunt the harmful effects of chronic sympathetic activation, lower heart rate and afterload, and promote favorable cardiac remodeling, with large trials demonstrating reduced mortality and fewer hospitalizations.

Because these medications can lower blood pressure and slow the pulse, monitoring during initiation and uptitration is essential. The key parameters to track are blood pressure and heart rate to avoid hypotension and bradycardia, and watch for signs that the heart failure is not well compensated, such as increased dyspnea, weight gain, edema, or other decompensation symptoms. Patients should report dizziness, fatigue, or fluid-related symptoms promptly so therapy can be adjusted. Other beta-blockers have not shown consistent mortality benefits in HFrEF, which is why the focus is on these three and careful hemodynamic monitoring.